Need help deciphering my pathology report.

coastalaggie

I was so shaken up after leaving the dr office yesterday that I did not realize he had given my full pathology report. This morning I found it on the car seat while dropping the kids off at school. So here goes:

Pathological stage: pTis (DCIS), pNX-- not sure what pNX means or pTis

I have multifocal low grade ductal carcinmoma in situ, cribiform, micropapillary, and papillary types with rare calcifications; DCIS extends over 3 cm in greatest dimension. intraductal papillomas in almost all of the excised tissue margins

NEGATIVE for invasive carcinoma at this time.. phew!

Size extent of DCIS: 3.5 centimeters in greatest combined dimension.

ER+ (3+ staining in 100% nuclei).. not sure what 3+ means

Prog+ (2-3+ staining in 95% nuclei).. not sure what the 2-3 means

This is the right breast and I was told my only real option for that breast is masectomy because of the size and extent and I have small dense breasts. I am opting for bilateral because of the density of my breasts and because honestly this whole thing scares the sh*t out of me. I read a recent article (published 2017) that indicates breast density with breast cancer in one breast puts you at significant risk of a new cancer in the opposite breast. My dr did not bat an eye when I suggested the other breast too. He said he did not like the multiple papillomas (I guess this is technically called multifocal DCIS) all over at my younger age, etc.

Lula73

so sorry to hear of your diagnosis, but welcome to the site! I'll see if I can help you decipher a little of the pathology: pTis means DCIS, pNx means nodes not accessible (nodes not accessible makes sense with just biopsy of lump site). The samples of tissue taken are ER+ and PR+ (This is good because it means the cancer cells feed on estrogen and progesterone which means once the tissue is removed, you can take medications that will block those estrogen receptors and basically starve any cancer cells that might have gotten left behind.

As you're making your choices on your surgery path, remember that you have options beyond implants. Natural tissue reconstruction is another option for more natural looking breasts that age with you just as your originals would have. And the reconstruction can be done during the same procedure as the mastectomy. (If none of the docs in your area do natural tissue reconstruction they usuallywon't even bring it up-they will only offer you implants and tell you you're not a candidate for natural tissue). For more information on this type of reconstruction check out www.breastcenter.com. I traveled there for mine and it was one of the best decisions I've ever made. Feel free to reach out and ask any questions you may have!

BarredOwl

Hi coastalaggie:

Sorry to hear of your recent diagnosis. You will find a lot of information and support here.

Under AJCC staging criteria (7th edition) summarized here, the abbreviations in your pathology report have specific definitions:

https://cancerstaging.org/references-tools/quickreferences/Documents/BreastMedium.pdf

pTis (DCIS) = "Ductal carcinoma in situ"

pNX = "Regional lymph nodes cannot be assessed (for example, previously removed, or not removed for pathologic study)"

In the USA, DCIS is commonly tested for estrogen receptor ("ER") status and progesterone receptor ("PR") status. Here is a very short introduction from the main site:

http://www.breastcancer.org/symptoms/diagnosis/hormone_status

My layperson understanding is that the overall result in your case is considered to be ER-positive (ER+) and PR-positive (PR+). When using immunohistochemistry ("IHC") (antibody-based detection methods) to assess nuclear staining for estrogen receptor protein ("ER") or progesterone receptor protein ("PR"), one can assess: (a) the percentage of cells in a field of view that show any staining; and (b) the intensity of the staining. The 100% and 95% values would be the percentage of cells that show any ER or PR staining, respectively. The 2+ and 3+ designations are probably designations that indicate the degree or intensity of the staining (0; 1+ or +; 2+ or ++; 3+ or +++, with 3+ being the most intense). The intensity of staining may be relatively consistent across cells in the sample (3+ for ER) or may vary somewhat from cell to cell (from 2+ to 3+ for PR). Please confirm it with your team.

ER+ and/or PR+ status is generally considered to be a favorable pathologic finding (as being more similar to normal breast cells that are ER+ and PR+). ER and/or PR positive status may lead to consideration of endocrine therapy (also referred to as "anti-hormonal" therapy; e.g., tamoxifen or an aromatase inhibitor) in the appropriate case. In those found to have pure DCIS after definitive surgical treatment, a recommendation for endocrine therapy tends to be more common in those who received breast-conserving surgery (lumpectomy) or unilateral mastectomy than in those who received bilateral mastectomy. Individual decisions reflect a personalized risk/benefit analysis and the personal risk tolerance of the patient.

This page from the main site includes a link to a pamphlet (scroll to bottom and download PDF pamphlet) which contains helpful information about pathology reports:

http://www.breastcancer.org/symptoms/diagnosis/getting_path_report

Note that not all tests are applicable to DCIS. For example, DCIS is not routinely tested for HER2.

On the main site here, I found this link (below) with illustrations to be helpful for understanding ductal carcinoma in situ ("DCIS"), which by determination of the pathologist appears to be physically confined to the inside of the ducts, and which by this pathologic criterion is considered "non-invasive" (i.e., has not broken through the wall of the duct into the surrounding breast tissue). The page also includes some information about grade, and farther down (keep scrolling), there are explanations and illustrations of various terms used to describe the architecture or how "clogged" the duct appears (e.g., papillary, cribiform, solid):

http://www.breastcancer.org/symptoms/types/dcis/diagnosis

Many new members find these comprehensive posts from Beesie to be extremely helpful. You may wish to bookmark them, and return to them as you move forward, because it is a large amount of information to absorb.

A layperson's guide to DCIS (original post):

https://community.breastcancer.org/forum/68/topics/790992?page=1

Lumpectomy vs Mastectomy Considerations (see Jun 13, 2013 post)

https://community.breastcancer.org/forum/68/topics/806074?page=1#post_3589278

Best,

BarredOwl